Download PDF
Klin Padiatr 2014; 226(06/07): 344-350
DOI: 10.1055/s-0034-1387747
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Kraniopharyngeom mit hypothalamischer Adipositas – Stationäre Rehabilitation ohne Einfluss auf die Gewichtszunahme bei Kindern und Jugendlichen

Childhood Craniopharyngioma with Hypothalamic Obesity – No Long-term Weight Reduction due to Rehabilitation Programs
A. S. Sterkenburg
1   University Medical Center (UMCG), University of Groningen, Groningen, Netherlands
,
A. Hoffmann
2   Klinik für Allgemeine Kinderheilkunde, Hämatologie/Onkologie, Zentrum für Kinder- und Jugendmedizin, Klinikum Oldenburg, Medizinischer Campus Universität Oldenburg, Oldenburg
,
U. Gebhardt
2   Klinik für Allgemeine Kinderheilkunde, Hämatologie/Onkologie, Zentrum für Kinder- und Jugendmedizin, Klinikum Oldenburg, Medizinischer Campus Universität Oldenburg, Oldenburg
,
E. Waldeck
3   Edelsteinklinik, Fachklinik für Kinder- und Jugendrehabilitation, Bruchweiler
,
S. Springer
4   Klinik Hochried, Zentrum für Kinder, Jugendliche und Familien, Murnau
,
H. L. Müller
2   Klinik für Allgemeine Kinderheilkunde, Hämatologie/Onkologie, Zentrum für Kinder- und Jugendmedizin, Klinikum Oldenburg, Medizinischer Campus Universität Oldenburg, Oldenburg
› Author Affiliations
Further Information

Publication History

Publication Date:
28 November 2014 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Hintergrund: Die Lebensqualität von Kindern und Jugendlichen mit Kraniopharyngeom wird häufig durch eine hypothalamische Adipositas beeinträchtigt. Der Einfluss stationärer Rehabilitationsmaßnahmen (Reha) auf den langfristigen Gewichtsverlauf ist bislang nicht untersucht.

Patienten und Methoden: Im Rahmen einer retrospektiven Querschnittuntersuchung konnten 108 Patienten aus HIT-Endo, die vor 2001 rekrutiert wurden und von denen 31 (29%) eine (n=4) oder mehrere (n=21) Reha in 13 Kliniken absolviert hatten, ausgewertet werden hinsichtlich Gewichtsverlauf (BMI-SDS) nach >10 Jahren Nachbeobachtung in Abhängigkeit von der Durchführung einer Reha.

Ergebnisse: Die Indikation zur Reha war in 84% der Patienten eine hypothalamische Adipositas. 12% der rehabilitierten Patienten boten zu Beginn der Reha einen BMI<+ 2 SD. Patienten, die eine Reha erhielten, boten bereits bei Diagnose (medianer BMI: +1.32 SD; Spannweite: −1.08 bis + 7.00 SD) und bei letzter Evaluation (BMI: +4.93 SD; Spannweite: −0.20 bis + 13.13 SD) einen höheren BMI als Patienten, die keine Reha erhielten (BMI bei Diagnose: +0.24 SD; Spannweite: −2.67 bis + 6.98 SD; BMI bei Evaluation: +2.09 SD; Spannweite: − 1.48 bis + 10.23 SD). Eine langfristige Beeinflussung des Gewichtsverlaufs von Patienten mit hypothalamischer Adipositas ließ sich durch Reha nicht erzielen unabhängig vom Grad der Adipositas, von der Anzahl durchgeführter Reha und der Rehabilitationsklinik.

Schlussfolgerungen: Die Optionen zur Behandlung der hypothalamischen Adipositas im Rahmen von Reha sind limitiert, sodass der Prävention therapiebedingter hypothalamischer Läsionen und der psychosozialen Unterstützung im Rahmen der Reha eine entscheidende Bedeutung zukommt.

Abstract

Background: Severe obesity due to hypothalamic involvement has major impact on prognosis in long-term survivors of childhood craniopharyngioma. The long-term effects of rehabilitation efforts on weight development and obesity in these patients are not analyzed up to now.

Patients and Methods: 108 patients with childhood craniopharyngioma recruited in HIT Endo before 2001 were included in the study. Long-term weight development (BMI SDS after >10 yrs follow-up) was analyzed in regard to rehabilitation, which was performed in 31 of 108 (29%) patients (one rehabilitation in 4 patients (13%), more than one in 21 patients (68%), 6 patients unknown) in 13 German rehabilitation ­clinics.

Results: 84% of patients underwent rehabilitation in order to reduce hypothalamic obesity (BMI>+ 2 SD), whereas 12% of patients were normal weight. Childhood craniopharyngioma pa­tients with rehabilitation presented with higher BMI at diagnosis (median BMI: +1.32 SD; range: −1.08 to + 7.00 SD) and at last evaluation (median BMI: +4.93 SD; range: −0.20 to + 13.13 SD) when compared with patients without rehabilitation (median BMI at diagnosis: +0.24 SD; range: −2.67 to + 6.98 SD; BMI at evaluation: +2.09 SD; range: −1.48 to + 10.23 SD). A long-term weight reducing effect of rehabilitation was no detectable regardless of degree of obesity, frequency of rehabilitation, and hospital of rehabilitation.

Conclusion: Treatment options for hypothalamic obesity in terms of rehabilitation are limited. Accordingly, strategies for prevention of hypothalamic lesions and psychosocial effects of rehabilitation are currently in focus for improvement of prognosis in childhood craniopharyngioma patients.

Schlüsselwörter

Kraniopharyngeom - Hypothalamus - Adipositas - Rehabilitation - Hirntumore - Lebensqualität

Key words

craniopharyngioma - hypothalamus - obesity - rehabilitation - brain tumours - quality of life
 

  • Literatur

  • 1 Besier T, Fuchs B, Rosenberger T et al. Evaluation of an inpatient parent-child-rehabilitation program: symptoms of psychological distress and quality of life. Psychother Psychosom Med Psychol 2011; 61: 418-425
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Bretault M, Boillot A, Muzard L et al. Bariatric surgery following treatment for craniopharyngioma: a systematic review and individual-level data meta-analysis. J Clin Endocrinol Metab 2013; 98: 2239-2246
    CrossrefPubMedGoogle Scholar
  • 3 de Vile CJ, Grant DB, Hayward RD et al. Obesity in childhood craniopharyngioma: relation to post-operative hypothalamic damage shown by magnetic resonance imaging. J Clin Endocrinol Metab 1996; 81: 2734-2737
    CrossrefPubMedGoogle Scholar
  • 4 Flitsch J, Muller HL, Burkhardt T. Surgical strategies in childhood craniopharyngioma. Front Endocrinol (Lausanne) 2011; 2: 96
    PubMedGoogle Scholar
  • 5 Göbel U, Körholz D, Bernig T et al. Treatment of children and adolecents with cancer after the application of the guide lines for good clinical practice in 2004 and the evaluation of new measurements. Klin Padiatr 2012; 224: 335-338
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Goldbeck L, Holling I, Schlack R et al. The impact of an inpatient family-oriented rehabilitation program on parent-reported psychological symptoms of chronically ill children. Klin Padiatr 2011; 223: 79-84
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Harz KJ, Muller HL, Waldeck E et al. Obesity in patients with craniopharyngioma: assessment of food intake and movement counts indicating physical activity. J Clin Endocrinol Metab 2003; 88: 5227-5231
    CrossrefPubMedGoogle Scholar
  • 8 Hoffmann A, Warmth-Metz M, Gebhardt U et al. Childhood craniopharyngioma – changes of treatment strategies in the trials KRANIOPHARYNGEOM 2000/2007. Klin Padiatr 2014; 226: 161-168
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Kordes U, Flitsch J, Hagel C et al. Ectopic craniopharyngioma. Klin Padiatr 2011; 223: 176-177
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Kortmann RD. Different approaches in radiation therapy of craniopharyngioma. Front Endocrinol (Lausanne) 2011; 2: 100
    PubMedGoogle Scholar
  • 11 Lustig RH, Hinds PS, Ringwald-Smith K et al. Octreotide therapy of pediatric hypothalamic obesity: a double-blind, placebo-controlled trial. J Clin Endocrinol Metab 2003; 88: 2586-2592
    CrossrefPubMedGoogle Scholar
  • 12 Mason PW, Krawiecki N, Meacham LR. The use of dextroamphetamine to treat obesity and hyperphagia in children treated for craniopharyngioma. Arch Pediatr Adolesc Med 2002; 156: 887-892
    CrossrefPubMedGoogle Scholar
  • 13 Muller HL. Childhood craniopharyngioma--current concepts in diagnosis, therapy and follow-up. Nat Rev Endocrinol 2010; 6: 609-618
    CrossrefPubMedGoogle Scholar
  • 14 Muller HL. Consequences of craniopharyngioma surgery in children. J Clin Endocrinol Metab 2011; 96: 1981-1991
    CrossrefPubMedGoogle Scholar
  • 15 Muller HL. Paediatrics: Surgical strategy and quality of life in craniopharyngioma. Nat Rev Endocrinol 2013; 9: 447-449
    CrossrefPubMedGoogle Scholar
  • 16 Muller HL. Craniopharyngioma. Endocr Rev 2014; 35: 513-543
    CrossrefPubMedGoogle Scholar
  • 17 Muller HL, Emser A, Faldum A et al. Longitudinal study on growth and body mass index before and after diagnosis of childhood craniopharyngioma. J Clin Endocrinol Metab 2004; 89: 3298-3305
    CrossrefPubMedGoogle Scholar
  • 18 Muller HL, Gebhardt U, Faldum A et al. Xanthogranuloma, Rathke’s cyst, and childhood craniopharyngioma: results of prospective multina­tional studies of children and adolescents with rare sellar malformations. J Clin Endocrinol Metab 2012; 97: 3935-3943
    CrossrefPubMedGoogle Scholar
  • 19 Muller HL, Gebhardt U, Maroske J et al. Long-term follow-up of morbidly obese patients with childhood craniopharyngioma after laparoscopic adjustable gastric banding (LAGB). Klin Padiatr 2011; 223: 372-373
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Muller HL, Gebhardt U, Pohl F et al. Relapse pattern after complete resection and early progression after incomplete resection of childhood craniopharyngioma. Klin Padiatr 2006; 218: 315-320
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Muller HL, Gebhardt U, Teske C et al. Post-operative hypothalamic le­sions and obesity in childhood craniopharyngioma: results of the multinational prospective trial KRANIOPHARYNGEOM 2000 after 3-year follow-up. Eur J Endocrinol 2011; 165: 17-24
    CrossrefPubMedGoogle Scholar
  • 22 Muller HL, Gebhardt U, Wessel V et al. First experiences with laparoscopic adjustable gastric banding (LAGB) in the treatment of patients with childhood craniopharyngioma and morbid obesity. Klin Padiatr 2007; 219: 323-325
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Muller HL, Muller-Stover S, Gebhardt U et al. Secondary narcolepsy may be a causative factor of increased daytime sleepiness in obese childhood craniopharyngioma patients. J Pediatr Endocrinol Metab 2006; 19: 423-429
    PubMedGoogle Scholar
  • 24 Ozyurt J, Thiel CM, Lorenzen A et al. Neuropsychological outcome in patients with childhood craniopharyngioma and hypothalamic involvement. J Pediatr 2014; 164: 876-881 e874
    CrossrefPubMedGoogle Scholar
  • 25 Rolland-Cachera MF, Cole TJ, Sempe M et al. Body Mass Index variations: centiles from birth to 87 years. Eur J Clin Nutr 1991; 45: 13-21
    PubMedGoogle Scholar
  • 26 Roth C, Wilken B, Hanefeld F et al. Hyperphagia in children with craniopharyngioma is associated with hyperleptinaemia and a failure in the downregulation of appetite. Eur J Endocrinol 1998; 138: 89-91
    CrossrefPubMedGoogle Scholar
  • 27 Roth CL, Hunneman DH, Gebhardt U et al. Reduced sympathetic metabolites in urine of obese patients with craniopharyngioma. Pediatr Res 2007; 61: 496-501
    CrossrefPubMedGoogle Scholar
  • 28 Siegrist M, Rank M, Wolfarth B et al. Leptin, adiponectin, and short-term and long-term weight loss after a lifestyle intervention in obese children. Nutrition 2013; 29: 851-857
    CrossrefPubMedGoogle Scholar
  • 29 Srinivasan S, Ogle GD, Garnett SP et al. Features of the metabolic syndrome after childhood craniopharyngioma. J Clin Endocrinol Metab 2004; 89: 81-86
    CrossrefPubMedGoogle Scholar
  • 30 Sterkenburg AS, Niekrens C, Hoffmann A et al. Reactive Pituitary Enlargement Mimicking a Sellar Mass. Klin Padiatr 2014; 226: 375-376
    Article in Thieme ConnectPubMedGoogle Scholar